Program Selection

I wish to apply for both Programs

John R. Justice Federal Grant Program
State of Delaware Public Attorney Student Loan Repayment Assistance Program

Only the John R. Justice Federal Grant Program Only the State of Delaware Public Attorney Student Loan Repayment Assistance Program

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Applicant Information

First Name*

Middle Name

Last Name*

SSN*

Date Of Birth*

Gender*

Race*

Ethnicity*

Contact Number*

Email*

Home Address

Address 1*

Address 2

City*

State*

Zip*

Family & Life Circumstance

Are you married ?

Family & Life Circumstance

If there is anything beyond the above about your financial situation that would be relevant to establishing financial need on your part, please describe it (and be willing to provide any relevant documentation if requested)

Employment

Are you employed full time ?

Workplace Information

Date of Hire

Official Job Title/Classification

Salary for Calendar Year 2023*

Workplace Contact

HR Name*

HR Contact*

HR Email*

Workplace Address

Address 1*

Address 2

City*

State*

Zip*

Sign employment verification

Employment

Legal Area that you practice in

Upload Tax Document

2022 Federal Tax Return

Year 2023*, W-2

Licensure

Are you licensed to practice law ?

State in which you are licensed

License Number in Delaware

Date Admitted to Delaware Bar

Degree

Law Degree From*

Graduation Year*

Undergraduate Degree From*

Graduation Year*

Service Agreement John R. Justice Requirement

Received a John R. Justice loan repayment assistance award payment in the past?

Service Agreement Student Loan Program Requirement

Employed at the State of Delaware, CLASI, DVLS, or LCSD for at least one year?

Education Debt

Total Outstanding Balance:

Add More

Student Loan Repayment Program

Program Selection

John R Justice Federal Grand Program
State of Delaware Public Attorney Student Loan Program

Applicant Information

Name

Date of Birth

SSN

Gender

Race

Ethnicity

Home Address 1

Address 2

City

State

Zip

Contact Number

Email

Family & Life Circumstance

Are you married?

Spouse's Name

Spouse's Employment

Spouse's Current Salary

Do you have Children?

Employment

Are you employed?

Tax

Tax Documents

Licensure

Are you licensed to practice law?

Degree

Law Degree from

Law Degree Graduation Year

Undergraduate Degree from

Undergraduate Degree Graduation Year

Other

Are you currently planning/hoping to receive student loan forgiveness under the public Service Loan Forgiveness(PSLF) program or another Federal Loan Forgiveness Program ?

Education Debt

#	Lender Services	Loan Acc#	Outstanding	Agreements

By signing, I certify that all the information on this application is true and complete to the best of my knowledge. If asked by the Delaware Criminal Justice Council, I will provide proof of the information I have given on this application.

Submit

Start

Public Attorney Student Loan Repayment Programs

~ Employment Verification Letter ~

Name
{applicant_name}

Address
{applicant_address1}
{applicant_city}, {applicant_state}, {applicant_zip}

I authorize my employer {employer_name}, to provide the employment information requested by the Criminal Justice Council.

HR Contact
{hr_contact_name}
{hr_contact_phone}
{hr_contact_email}
{applicant_address1}
{applicant_city}, {applicant_state}, {applicant_zip}

{sign_here}

Start

Name:	{applicant_name}
Home Address:	{applicant_address}
Cell Phone:	{applicant_contact}
Work Phone:	{workplace_contact}
Email:	{applicant_email}

Financial Institution	Account Number#	Present Balance
{lender_service} {workplace_add1} {workplace_city} {workplace_state} {workplace_zip} {workplace_phone}	{account_no}	{outstanding_balance}

Name:	{applicant_name}
Home Address:	{applicant_address}
Cell Phone:	{applicant_contact}
Work Phone:	{workplace_contact}
Email:	{applicant_email}

Financial Institution	Account Number#	Present Balance
{lender_service} {workplace_add1} {workplace_city} {workplace_state} {workplace_zip} {workplace_phone}	{account_no}	{outstanding_balance}

Public Attorney Student Loan Repayment Assistance Programs

Student Loan Repayment Program

Applicant Information

Family & Life Circumstance

Employment

Tax

Licensure

Degree

JRJ Service Agreement Requirements

HB 380 Service Agreements Requirement

Other

Education Debt

Public Attorney Student Loan Repayment Programs

~ Employment Verification Letter ~

Public Attorney Student Loan Repayment Programs

Name:

{applicant_name}

Home Address:

{applicant_address}

Cell Phone:

{applicant_contact}

Work Phone:

{workplace_contact}

Email:

{applicant_email}

Financial Institution

Account Number#

Present Balance

{lender_service}{workplace_add1}{workplace_city} {workplace_state} {workplace_zip}{workplace_phone}

{account_no}

{outstanding_balance}

Public Attorney Student Loan Repayment Programs

Name:

{applicant_name}

Home Address:

{applicant_address}

Cell Phone:

{applicant_contact}

Work Phone:

{workplace_contact}

Email:

{applicant_email}

Financial Institution

Account Number#

Present Balance

{lender_service}{workplace_add1}{workplace_city} {workplace_state} {workplace_zip}{workplace_phone}

{account_no}

{outstanding_balance}

Criminal Justice Council

{lender_service}
{workplace_add1}
{workplace_city} {workplace_state} {workplace_zip}
{workplace_phone}

{lender_service}
{workplace_add1}
{workplace_city} {workplace_state} {workplace_zip}
{workplace_phone}